Innovations in Multimodality Therapy for Lung Cancer

Combined Modality Management of Limited Small-Cell Lung Cancer

¹ The Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor.

Chemotherapy with PE provides an opportunity to use thoracic radiotherapy with fewer side effects and better survival. The optimal dose and duration of systemic therapy remain to be defined. Early, concurrent thoracic radiotherapy appears to produce more esophagitis and granulocyte toxicity than chemotherapy alone. Despite profound symptomatic toxicity, it's rarely fatal and usually reversible. Regimens using PE and thoracic radiotherapy are associated with better survival than in older series, but stage migration and nontreatment variables may be responsible for a portion of this difference. Optimal dose, timing, and fractionation techniques are not clearly defined and are subjects of ongoing clinical research. Issues regarding prophylactic cranial irradiation remain quite contentious—a randomized trial will attempt to shed some light on this highly contested debate.